Various approaches to laparoscopic single-site surgery (LESS) have been developed to reduce pain and other complications, promote recovery, and improve cosmetic outcomes, particularly relative to conventional open or laparoscopic surgery. Three-port procedures for LESS have been reported to be superior to single-port access, but they usually require expensive, technically sophisticated instruments. To avoid these problems, we have developed a modified procedure for performing LESS with a single port, referred to as the "Obama system." From January 2009 through December 2010, we performed laparoscopic cholecystectomy (LC) in 61 patients. Conventional LC with three ports was performed in 39 patients, LESS with a SILS Port was performed in 4 patients, and modified LESS was performed using the Obama system in 18 patients. The operative results were compared. LC was successfully completed in all 61 patients, with no postoperative complications. The mean operating time was 102.3 min (C-reactive protein [CRP] ≤ 2) and 160.1 min (CRP > 2) in the 39 patients who underwent conventional LC, 108.3 min (CRP ≤ 2) in the 4 patients who underwent LESS with a SILS Port, and 116.5 min (CRP ≤ 2) and 186.5 min (CRP > 2) in the 18 patients who underwent LESS using the Obama system. No morbidity or mortality was associated with any technique. The Obama system is easier to use and more efficient and reliable than any other technique currently available for LESS. This system is expected to greatly contribute to the further development and wider acceptance of LESS.
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